The FDA recently approved onabotulinum toxin A (more commonly known as “Botox”) for the treatment of chronic migraines. Chronic migraines are defined as occurring on 15 days or more per month. Headache specialists have been injecting onabotulinum toxin A for migraine prevention for many years. It is a generally safe treatment, although safety and effectiveness should be discussed with your doctor. One of the nice things about Botox injections for migraine prevention is that if it works, it usually has none of the potential side effects that some of the prescription medications have. For people who have tried other medications and modalities, it is a great option to discuss with your doctor.
Injections are done in the office, and take the same time as a regular office visit. No special preparation is needed, and afterwards you can go about your day as your normally would with little restrictions.
Botox can be used for several other neurological conditions as well, in addition to cosmetic uses.
Botulinum toxin injections have been studied for treating headaches for many years. Results of some of the big studies were mixed, but many headache specialists still use it, and here’s why… it works. At least in some patients. For years, we have known that while many patients may not respond to botulinum toxin injections, some do, and sometimes in a dramatic way with near complete resolution of headaches.
A recent study published in the February issue of Archives of Dermatology by Kim, et al., attempted to identify a subtype of migraine that might respond more robustly to this treatment. The study was small, but certain types of headache seemed to respond better than others. This type of study needs to be reapeated with larger numbers of patients to see if this is a real phenomenon. This may help explain, though, the experience of neurologists using botulinum toxin for migraine and other headaches… that some people respond wonderfully, and others get no benefit. Maybe we were on to something. In the future, we may be able to use the individual characteristics of a person’s headaches to choose the best treatment options more reliably.
There may be several different characteristics of headaches that may make you a good candidate for the treatment, so you need to speak to your doctor about it.